Urodynamics Flashcards
Provides a first impression of the voiding function and is compulsory prior to planning any invasive urodynamics in patients able to void
Free uroflowmetry and assessment of residual urine
Possible pathological findings include DO, low bladder compliance, abnormal bladder sensations, incontinence, and an incompetent or relaxing urethra.
Filling cystometry
Appears to have no use as a diagnostic tool. Some positive findings have been reported, but sensitivity is too low to estimate the risk to the UUT or for secondary bladder damage
Detrusor leak point pressure
Reflects the coordination between detrusor and urethra or pelvic floor during the voiding phase. Possible pathological findings include detrusor underactivity, bladder outlet obstruction (BOO), DSD, a high urethral resistance, and residual urine.
Pressure flow study.
Pressure-flow analysis mainly assesses the amount of mechanical obstruction caused by the urethra’s inherent mechanical and anatomical properties and has limited value in patients with neuro-urological disorders.
Reflects the activity of the external urethral sphincter, the peri-urethral striated musculature, the anal sphincter and the striated pelvic floor muscles.
EMG
Useful as a gross indication of the patient’s ability to control the pelvic floor. Possible pathological findings include inadequate recruitment upon specific stimuli (e.g. bladder filling, involuntary detrusor contractions, onset of voiding, coughing, Valsalva manoeuvre) suggesting a diagnosis of DSD
The combination of filling cystometry and pressure flow studies with imaging. It is the optimum procedure for urodynamic investigation in neuro-urological disorders
Video-urodynamics
Possible pathological findings include DO, low bladder compliance, abnormal bladder sensations, incontinence, and an incompetent or relaxing urethra.
Possible pathological findings include detrusor underactivity, bladder outlet obstruction (BOO), DSD, a high urethral resistance, and residual urine
Test that will discriminate between UMN and LMN lesions
Fast filling cystometry
Patients with upper motor neuron lesions develop a detrusor contraction if the detrusor is intact, while patients with lower motor neuron lesions do not.
First line medical treatment for neurogenic detrusor overactivity
antimuscarinics
Medical treatment to decrease bladder outlet resistance
Alpha blockers
Novel medication that DOES NOT improve urodynamic outcomes in neurogenic detrusor overactivity
Mirabegron
Standard treatment for patients who are unable to empty their bladders
IC
IFC for neurogenic bladders
AVOID WHENVER POSSIBLE
Oxybutynin oral has poor response, what will you do next
Offer intravesical oxybutynin
MS/SCI patient with NDO, antimuscarinic therapy is ineffective, what can you ofer
Botulinum toxin injection in the detrusor to reduce NDO
Indication for bladder neck incision
Secondary changes like fibrosis at the bladder neck
Treatment for refractory neurogenic detrusor overactivity
Bladder augmentation
51F
Neurogenic stress urinary incontinence
Able to self catheterise
What can you offer
Autologous urethral sling
51M
Neurogenic stress urinary incontinence
What can you offer
Artificial urinary sphincter
Screening and treatment for ABU
don’t.
just don’t.
Treatment of asymptomatic bacteriuria results in significantly more resistant bacterial strains without 1a improving patient outcome.
Long term antibiotics for recurrent UTIs
don’t.
just don’t.
Low-dose, long-term, antibiotic prophylaxis does not reduce UTI frequency, but increases bacterial 2a resistance.
First line medical treatment in neurogenic ED
Oral PDE5 inhibitor
Second line treatment in neurogenic ED
Give intracavernous injections of vasoactive drugs (alone or in combination) as second-line medical treatment in neurogenic ED.
Refractory neurogenic ED treatment
Offer mechanical devices such as vacuum devices and rings to patients with neurogenic ED
Sperm retrieval options in SCI
Perform vibrostimulation and transrectal electroejaculation for sperm retrieval in men with spinal cord injury.
Failed vibrostimulation or failed electroejaculation in men with SCI, what can you offer next?
MESA
TESA
ICSI
